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This is VAERS ID 153392

Case Details

VAERS ID: 153392 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: Nevada  
Vaccinated:2000-06-01
Onset:2000-06-02
   Days after vaccination:1
Submitted: 2000-06-08
   Days after onset:6
Entered: 2000-06-09
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 469396 / 1 LL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM ENG3137A2 / 2 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 601063A / 1 LL / IM
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / PASTEUR MERIEUX INST. R0235 / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Asphyxia, Unevaluable event
SMQs:, Acute central respiratory depression (broad), Hostility/aggression (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2000-06-02
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: PKU-nml
CDC Split Type:

Write-up: Pt did not wake up the morning after shots were given. Autopsy gives cause of death as positional asphyxia


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